Provider Demographics
NPI:1013206341
Name:HARRIS, BRENDA MARRON (LBSW)
Entity Type:Individual
Prefix:MRS
First Name:BRENDA
Middle Name:MARRON
Last Name:HARRIS
Suffix:
Gender:F
Credentials:LBSW
Other - Prefix:MS
Other - First Name:BRENDA
Other - Middle Name:MARRON
Other - Last Name:MEADOWS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LBSW
Mailing Address - Street 1:10159 BEACONSFIELD ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48224-2536
Mailing Address - Country:US
Mailing Address - Phone:313-245-7000
Mailing Address - Fax:313-245-7009
Practice Address - Street 1:20303 KELLY RD
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48225-1206
Practice Address - Country:US
Practice Address - Phone:313-245-7000
Practice Address - Fax:313-245-7009
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-07
Last Update Date:2011-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6802069759104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker